Dr. William Iobst
Preventive Medicine -Create “Blue Zones” in NEPA
Guest CoAuthor: William F. Iobst, M.D., FACP is vice president for academic and clinical affairs and vice dean at The Commonwealth Medical College. He is a national leader in competency-based medical education and assessment of trainee performance. Prior to joining TCMC, Dr. Iobst served as vice president for academic affairs at the American Board of Internal Medicine (ABIM).
The media is captivated by the idea that a small, remote population – be it in the Himalayas or by the Mediterranean Sea – has discovered the secret to a long, healthy life. In these pages just last year you may recall Dr. Mackarey talking about “blue zones,” five specific locations on the planet where people enjoy life well past age 90. It’s intriguing to believe that an exotic locale or rare tropical fruits hold the magic charm to longevity. The reality is less magical. The truth is long-lived communities observe particular patterns of behavior and consistently make healthy choices we can all learn from and adopt.
We can think of these patterns of behavior as a form of medicine and the best form: preventive medicine. At The Commonwealth Medical College (TCMC), we are devoted to educating physicians of the future who recognize that medicine’s focus should include a focus on wellness. Moreover, our community emphasis at TCMC means we are deeply concerned with population health, which means we identify and work to change the unhealthy tendencies of the northeastern Pennsylvania population as a whole, tendencies that result in our having high rates of everything from cardiovascular disease to cancer to suicide. Let’s looks at how individuals can benefit from the preventive/wellness habits of blue zones AND how population health measures can be applied to benefit everyone.
When we think of our local population and compare it to the habits of the long-lived “blue zones,” what do we see? We see people who follow all the healthy rules many of us know but few of us follow: maintain a healthy weight, exercise, reduce your stress. In NEPA, many of us fall short of those wellness goals and we blame ourselves for lacking willpower or discipline. While it is certainly true that individuals should strive daily to make healthy decisions, when we look at the entire population, it’s obvious that there are very real differences between the population habits of NEPA and “blue zone” habits.
Let’s look at NEPA through the lens of population health and compare it to “blue zones.” As Dr. Mackarey wrote in 2015, below are some of the healthy behaviors associated with long-lived populations. As we discuss these behaviors through the lens of population health and wellness, it’s important to remember that individuals should always try to make wise decisions. Talking about barriers to wellness is a way for us to become aware of our unique challenges. We should not allow them to prevent us from achieving and preserving good health.
- MOVE MORE: Inhabitants of “blue zones” move a lot. Although they may not follow formal exercise routines, physical activity is woven into the fabric of their everyday existence. Activity is essential to good health, but when analyzing population health, it’s important to acknowledge the barriers we face in NEPA that perhaps a person on a remote Japanese island does not. Many area residents work eight or nine hours a day at a sedentary job. They live in neighborhoods that may not have accessible, well-lit places to walk or jog in the evening. The role of population health is to identify things that prevent us from exercise and find ways for the community to overcome them. The answers usually involve many stakeholders, from media to local government to healthcare. In this instance, a good public health program might include working with local municipalities to provide or improve facilities and engaging employers to offer on-site options for exercise. However, it does not have to be complex or hard. At an individual level, “move more” may simply mean we take the steps and not the elevator!
- EAT LESS: Another “blue zone” tendency Dr. Mackarey talked about focused on obesity – or the blue zones’ lack thereof. Healthy eating may come more easily to people who only have healthy choices. The culinary landscapes of Japan and Greece may be laden with fish, fruits and whole grains, but that does not describe the aisles of a typical American grocery store. Moreover, it’s unfortunate but true to note that sometimes it’s the fatty, salty, sugary food that helps stretch the family food dollar. A population health approach to the obesity problem includes education of both parents and children about healthy eating habits and choices. The education needs to be delivered in a multi-faceted way and would involve teachers, pediatricians and all healthcare providers – even employers. Public education on preventive health and wellness is also a key goal of TCMC. Other population health measures include providing plenty of opportunities for people to make healthy choices. In this case, local restaurants and markets could lead the way.
- MODERATION: Another “blue zone” habit is imbibing, but in moderation. By contrast, in NEPA, statistics show we tend to binge drink much more than state and national averages. Binge drinking not only encourages risky behavior (drinking and driving, for example), too much alcohol is linked to a number of illnesses, including liver disease, cardiovascular disease and cancer. Several studies have shown that law enforcement and local land-use and zoning can be used to decrease the incidence of binge drinking. We also know that simple screening and intervention methods put into daily use in primary-care practices have worked to decrease alcohol consumption.
- FAMILIES AND COMMUNITIES THAT CARE: One important ingredient in “blue zones” is a sense of purpose and a feeling of connection to community. Certainly when life seems meaningless or when individuals feel isolated, mental health suffers. In NEPA, we find a population that is much more prone to suicide than its state and national neighbors. How can we identify and reach out to those at risk? The answer is by taking a population-based approach. At TCMC, we believe in the lesson learned by the Centers for Disease Control when it studied suicide-prevention measures: “Improving overall community mental health can reduce the events of suicide more effectively than extensive efforts to identify the imminently suicidal individual.” This is precisely the thinking behind our Behavioral Health Initiative, which is addressing the unmet mental health needs of our region through a variety of measures, most notably a program for primary care physicians designed to give them the training and tools needed to care for their at-risk patients.
We can all learn from “blue zone” behavior and can individually commit to wellness and making the changes necessary to preserve it. However, as a community, we should also recognize that wellness isn’t solely the province of medicine. Every sector of community – from schools to law enforcement to government – can play a part. If we all work together, wellness and prevention are possible.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquiries related to this topic email: firstname.lastname@example.org
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.